Although we’ve made great strides over the last century making dental visits more pleasant and comfortable, many people still feel a little apprehension about them at one time or another. For a few, though, this apprehension escalates into high anxiety — so high they may even avoid important dental treatment altogether.

If you have a significant phobia regarding dental visits and treatment, here are some things you can do to reduce your anxiety and feel more comfortable when you undergo treatment.

Let us know about your feelings of anxiety. We’re conditioned by society to regard such fears as irrational or “silly,” and so we tend to hide our negative emotions. Dentists, however, have been trained to work with fearful patients to reduce their anxiety levels. Being honest with us about your fears and nervousness is the first step to developing an anxiety-reducing strategy that will make your visits more pleasant.

Counteract bad experiences with good. For most people the fear they have during dental visits stems from earlier unpleasant experiences at the dentist. The fear can be so ingrained that simply trying to convince yourself or to be told “there’s nothing to be afraid of” will have little to no effect. Instead, build a memory collection of positive and pleasant dental visit experiences that serve to counteract the unpleasant. To do this we might first get you acclimated to routine visits and then gradually transition to more invasive procedures. This may increase the normal time for dental treatment, but the reduction in anxiety is worth the extra time.

Consider sedation therapy. In addition to modifying your experiences, you may also benefit from sedation medications that reduce anxiety, especially in the early stages of treatment. Depending on your medical history and current status, we can prescribe a sedative for you to take an hour or so before your appointment to help you relax. We can also increase the level of anesthesia (from local to intravenous or gas anesthesia, for example) if your anxiety is especially acute.

Many people have questions about the proper use of antibiotics — especially today, as the overuse of these medications has become a concern. It isn’t necessary for most people to take antibiotics before having a dental procedure. But for a few — notably, those with particular heart conditions and, in some cases, joint replacements — pre-medication is advisable. The question may be even more confusing now, because the standard recommendations have recently changed — so let’s try and sort things out.

First, why would anyone need antibiotics before dental treatment? Essentially, it’s because of the chance that an open wound could allow bacteria from the mouth to enter the bloodstream. For people in good health, the body is capable of quickly containing and neutralizing the bacterial exposure. But people with some types of heart disease, heart transplants, and/or total joint replacements have a greater likelihood of developing a bacterial infection, which can be dangerous — or even life-threatening. The same may be true of people whose immune systems are compromised.

At one time, people with a broad range of heart problems and artificial joints were advised to pre-medicate; today, new research indicates that fewer people need to take this step. Antibiotics are currently recommended before dental procedures if you have:

An artificial heart valve, or a heart valve repaired with artificial material

A history of endocarditis

A heart transplant with abnormal heart valve function

Cyanotic congenital heart disease (a birth defect where blood oxygen levels are lower than normal) that hasn’t been fully repaired — including children with surgical shunts and conduits

A congenital heart defect that has been completely repaired with artificial material or with a device — but only for the first six months after the repair procedure

Repaired congenital heart disease with residual defects, such as leakage or abnormal flow

In addition, not everyone who has an artificial joint needs antibiotic premedication. Instead, your health care providers will rely on your individual medical history to determine whether this step is required in your situation. However, having a compromised immune system (due to diabetes, cancer, arthritis, chemotherapy and other factors) is still an indication that antibiotics may be needed.

The question of whether or not to pre-medicate is an important one — so it’s vital that you share all relevant medical information with your doctors and dentists, and make sure everyone is in the loop. That way, the best decisions can be made regarding your treatment.

One of the key elements in a child’s development is their first set of teeth. Although primary (“baby”) teeth last only a few years, they’re critically important for enabling a child to eat solid foods, speak and smile.

But they also provide one more important benefit—they hold the space in the jaw reserved for the permanent teeth developing just under the gums until they erupt. But if a child loses a primary tooth prematurely because of disease or injury, other teeth may drift into the vacant space and crowd it out for the intended permanent tooth. It may then come in misaligned or remain stuck within the gums (impaction).

To avoid this, we try to treat and preserve a diseased primary tooth if at all practical. For a primary molar, one of the large teeth in the back of the mouth, this might include capping it with a stainless steel crown.

Why a metal crown? Primary molars normally don’t fall out until around ages 10-12, so it may be years for a younger child before their permanent molars erupt. All during that time these particular teeth will encounter heavier biting forces than teeth in the front.

A steel crown is often the best solution for a molar given their longer lifespans and encountered biting forces. The crown’s metal construction can stand up to these forces while still protecting the tooth from re-infection from decay. And because molars are typically outside of the “smile zone” occupied by more visible front teeth, the crown’s metal appearance isn’t usually an aesthetic issue.

Crowning a molar usually takes one visit, a dentist typically performing the procedure with local anesthesia and possibly a mild sedative like nitrous oxide gas (“laughing gas”). After removing any decayed structure from the tooth, the dentist will then fit a pre-formed crown over the remaining structure, sized and shaped to match the original tooth as close as possible.

A stainless steel crown is a cost-effective way to added needed years to a primary molar that could otherwise be lost prematurely. Preserving it may help a child avoid bite problems and expensive future treatments.

Mayim Bialik has spent a good part of her life in front of TV cameras: first as the child star of the hit comedy series Blossom, and more recently as Sheldon Cooper’s love interest — a nerdy neuroscientist — on The Big Bang Theory. (In between, she actually earned a PhD in neuroscience from UCLA…but that’s another story.) As a child, Bialik had a serious overbite — but with all her time on camera, braces were just not an option.

“I never had braces,” she recently told Dear Doctor – Dentistry & Oral Health magazine. “I was on TV at the time, and there weren’t a lot of creative solutions for kids who were on TV.” Instead, her orthodontist managed to straighten her teeth using retainers and headgear worn only at night.

Today, there are several virtually invisible options available to fix orthodontic issues — and you don’t have to be a child star to take advantage of them. In fact, both children and adults can benefit from these unobtrusive appliances.

Tooth colored braces are just like traditional metal braces, with one big difference: The brackets attached to teeth are made from a ceramic material that blends in with the natural color of teeth. All that’s visible is the thin archwire that runs horizontally across the teeth — and from a distance it’s hard to notice. Celebs like Tom Cruise and Faith Hill opted for this type of appliance.

Clear aligners are custom-made plastic trays that fit over the teeth. Each one, worn for about two weeks, moves the teeth just a bit; after several months, you’ll see a big change for the better in your smile. Best of all, clear aligners are virtually impossible to notice while you’re wearing them — which you’ll need to do for 22 hours each day. But you can remove them to eat, or for special occasions. Zac Efron and Katherine Heigl, among others, chose to wear clear aligners.

Lingual braces really are invisible. That’s because they go behind your teeth (on the tongue side), where they can’t be seen; otherwise they are similar to traditional metal braces. Lingual braces are placed on teeth differently, and wearing them often takes some getting used to at first. But those trade-offs are worth it for plenty of people. Which celebs wore lingual braces? Rumor has it that the list includes some top models, a well-known pop singer, and at least one British royal.

So what’s the best way to straighten your teeth and keep the orthodontic appliances unnoticeable? Just ask us! We’d be happy to help you choose the option that’s just right for you. You’ll get an individualized evaluation, a solution that fits your lifestyle — and a great-looking smile!

Chicken pox is a common viral infection that usually occurs during childhood. Although the disease symptoms only last a short time, the virus that caused it may remain, lying dormant for years within the body's nervous system. Decades later it may reappear with a vengeance in a form known as herpes zoster, what most people know as shingles.

A shingles outbreak can be quite painful and uncomfortable—and it's also not a condition to take lightly. Occurring mainly in people over fifty, it often begins with an itching or burning sensation in the skin. This is often followed by a red rash breaking out in a belt-like pattern over various parts of the body, which may later develop into crusty sores. Symptoms may vary from person to person, but people commonly experience severe pain, fever and fatigue.

Besides the general discomfort it creates, shingles can also pose major health problems for certain people. Individuals with other health issues like pregnancy, cancer or a compromised immune system may experience serious complications related to a shingles outbreak.

In its early stages, shingles is contagious, spreading through direct contact with shingles sores or lesions or through breathing in the secretions from an infected person. This characteristic of shingles could affect your dental care: because the virus could potentially pass to staff and other patients, dentists usually postpone cleanings or other dental treatments for patients with shingles, particularly if they have a facial rash.

If you're diagnosed with shingles, most physicians recommend you begin antiviral treatment as soon as possible. You should also let your dentist know if you have shingles, which may put off any scheduled treatments until your doctor determines you're no longer contagious.

There's one other thing you can do, especially if you're over 60: obtain a shingles vaccine, available from most physicians or clinics. The vaccine has proven effective in preventing the disease, and could help you avoid this most unpleasant health experience.

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